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DOI: 10.1055/s-0042-1742824
Temporary Circulatory Support in Postcardiotomy Failure with Surgically Implantable Impella Devices: A Single-Center Experience
Background: In patients with refractory left ventricular failure after cardiac surgery, implantation of the Impella 5.0 or 5.5 device with a subclavian approach offers full hemodynamic support with simultaneous unloading of the left ventricle, thus enabling LV recovery and additional time for further treatment decisions.
Method: A retrospective data analysis on all patients receiving a surgically implanted Impella 5.0 or 5.5 for postcardiotomy failure between 07/2017 and 08/2021 after cardiac surgery were included. Patient charts were retrospectively reviewed for clinical characteristics, survival, and complications.
Results: Between 07/2017 and 08/2021, a total of 40 patients received postoperative support with either the Impella 5.0 (n = 16) or 5.5. (n = 24) after cardiac surgery. Mean age was 65.0 ± 11.1 years and 80% (n = 32) were male. Preoperative mean left ventricular ejection fraction in the cohort was 28.3 ± 11.4%. The majority of recipients underwent CABG surgery (n = 40; 60.0%). The remaining patients underwent aortic valve replacement (n = 2; 5.0%)), mitral valve replacement (n = 5; 12.5%), combined CABG and valve surgery (n = 6; 15.0%) or other cardiac surgeries (n = 3; 7.5%). The majority of surgeries were classified as urgent or emergency surgeries (n = 29; 72.5%).
In 19 patients (47.5%), Impella implantation was performed simultaneously with the cardiac surgery, whereas 21 (52.5%) received Impella support delayed after 1 (1; 3) day (median; IQR) following surgery. Additional ECLS support was implemented in 9 (22.5%) patients, in 6 of these patients simultaneously using the Impella for initial LV unloading. In all of these cases, the Impella was left in place after ECLS explantation for further LV support. In three patients, ECLS was initially used for hemodynamic support and later switched to Impella support. Overall, Impella support was necessary for 11.1 ± 5.9 days.
Thirty-day survival after surgery was 67.5% and after 6 months, 64.6% of the patients were still alive. Four patients were bridged to a permanent VAD.
Conclusion: In conclusion, the combined advantages of hemodynamic support and LV unloading of the surgically implantable Impella devices leads to a favorable outcome in patients with LV failure following cardiac surgery.
Publication History
Article published online:
03 February 2022
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